The W.A.T.I. Wisconsin Assistive Technology Initiative

Assistive TAAechnology

The WATI Assistive Technology Assessment is a process based, S systematic approach to providing a functional evaluation of the student’s need for assistive technology in his or her customary environment. (Please note: This is not a test protocol. There is no scoring involved.)

S Steps ‹ Information Gathering ‹ DECISION MAKING E ‹ TRIAL USE

The steps are supported by the following forms.

Forms page S ‹ OVERALL PROCESS Directions/Procedure Guide ...... 23

M ‹ INFORMATION GATHERING AT Consideration Guide ...... 25 Referral/Question Identification Guide ...... 27 E Student Information Guide ...... 29 Environmental Observation Guide...... 49

‹ DECISION MAKING N AT Decision Making Guide ...... 53 AT Checklist ...... 54

‹ TRIAL USE T AT Trial Use Guide ...... 56 AT Trial Use Summary...... 58

W.A.T.I. Assistive Technology Assessment Directions/Procedure Guide

School District/Agency School

Student Grade

Team Members Date Completed Comments

Gathering Information: Step 1: Team Members Gather Information Review existing information regarding child’s abilities, difficulties, environment, and tasks. If there is missing information, you will need to gather the information by completing formal tests, completing informal tests, and/or observing the child in various settings. The WATI Student Information Guide and Environmental Observation Guide are used to assist with gathering information. Remember, the team gathering this information should include parents, and if appropriate, the student.

Step 2: Schedule Meeting Schedule a meeting with the team. Team includes: parents, student (if appropriate), service providers (e.g. spec. ed. teacher, general ed. teacher, SLP, OT, PT, administrator), and any others directly involved or with required knowledge and expertise.

Decision Making: Step 3: Team Completes Problem Identification Portion of AT Planning Guide at the Meeting. (Choose someone to write all topics where everyone participating can see them.)

The team should move quickly through: Listing the student’s abilities/difficulties related to tasks (5-10 minutes). Listing key aspects of the environment in which the student functions and the student’s location and positioning within the environment (5-10 minutes). Identifying the tasks the student needs to be able to do is important because the team cannot generate AT solutions until the tasks are identified (5-10 minutes).

(Note: The emphasis in problem identification is identifying tasks the student needs to be able to do and the relationship of the student’s abilities/difficulties and characteristics of the environment of the child’s performance of the tasks.)

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Date Completed Comments

Step 4: Prioritize the List of Tasks for Solution Review trial use. Make any Generation needed decisions about permanent Identify critical task for which the team will generate potential use. Plan for permanent use solutions. This may require a redefining or reframing of the original referral question, but is necessary so that you hone in on the most critical task

Step 5: Solution Generation

Brainstorm all possible solutions.

Note: The specificity of the solutions will vary depending on the

knowledge and experience of the team members; some teams may

generate names of specific devices with features that will meet the

child’s needs, other teams may simply talk about features that are

important, e.g. “needs voice output,” “needs to be portable,” “needs

few (or many) messages,” “needs input method other than hands,”

etc. Teams may want to use specific resources to assist with solution

generation. These resources include, but are not limited to: the AT

Checklist, the ASNAT Manual, the Tool Box in Computer

Resources for People with Disabilities, Closing the Gap Directory,

and/or AT Consultant.

Step 6: Solution Selection Discuss the solutions listed, thinking about which are most effective for the student. It may help to group solutions that can be implemented 1) immediately, 2) in the next few months, and 3) in the future. At this point list names of specific devices, hardware, software, etc. If the team does not know the names of devices, etc., use resources noted in Step 5 or schedule a consultation with a knowledgeable resource person (that is the part of the decision- making that should require the most time. Plan on 20-30 minutes here).

Step 7: Implementation Plan Develop implementation plan (including trials with equipment) – being sure to assign specific names and dates, and determine meeting date to review progress (follow-up Plan). Reminder: Steps 3-7 occur in a meeting with all topics written where all participants can see them. Use a flip chart, board or overhead during the meeting, because visual memory is an important supplement to auditory memory. Following the meeting, ensure that someone transfers the information to paper for the child’s file for future reference.

Trial Use:

Step 8: Implement Planned Trials Step 9: Follow Up on Planned Date

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ive ive

s

uld be used to address this task below. Please leave blank ficiently, in the least restrict C. Describe new or additional be tried. assistive technology to

gy tools are currently being used (or gy

e to do at a level that reflects his/her skills/abilitie his/her reflects at a level that e to do School School tegies or accommodations? If yes, describe in Column A hardware, of software) that co B. If currently completes task with describe. assistive technology tools,

rsonal assistance? If yes, complete Column C. complete Column If yes, rsonal assistance? g)? Document by checking each relevant g)? Document by checking AT Checklist.) If any asssisitve technolo AT Checklist.) If any asssisitve nt to do, that s/he is unabl lete tasks with special stra lete tasks

echnology help the student perform this skill more easily or ef nt to the student’s IEP. nt to the student’s IEP. technology (either devices, tools, WATI Assistive Technol ogy Consideration Guide A. If currently completes task with special strategies/ accommodations, describe. Written Aspects of Writing Access (writing, reading, communicating, seeing, hearin any tasks that are not releva review WATI’s are know, task? (If none for each checked task. environment, or perform successfully with less pe successfully or perform environment, were tried in the past), describe Column B. Composing Motor Computer ˆ Material

ˆ Communication ˆ Reading ˆ Learning/ Studying Task ˆ ˆ Student’s Name Name Student’s 1. What task is it that we want this stude currently able to comp 2. Is the student 3. Is there available assistive 4. Would the use of assistive t

WATI Assessment Package (2004) 25 Overview of the Assessment and Planning Process

he needs? If

Date: gy, adapting or modifying t C. Describe new or additional tried. to be technology assistive

student that this staff, or family) student,

need for assistive technolo B. If currently completes task with tools, technology assistive describe.

(more specific evaluation of

stance on its operation or use, or training of or training or use, stance on its operation A. If currently completes task with special strategies/ accommodations, describe.

Activities of Activities Math Recreation ˆ yes, describe what will be provided, the initiation and duration. the initiation what will be provided, yes, describe

assistive technology, technical assi assistive Persons Present: Present: Persons Task ˆ ˆ and Leisure ˆ Mobility ˆ Environmental Control ˆ Positioning and Seating ˆ Vision ˆ Hearing 5. Are there assistive technology services Daily Living ADLs)

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Referral/Question Identification Guide

Student’s Name Date of Birth Age School Grade School Contact Person Phone Persons Completing Guide Date Parent(s) Name Phone Address Student’s Primary Language Family’s Primary Language

Disability (Check all that apply.) ˆ Speech/Language ˆ Significant Developmental Delay ˆ Specific Learning Disability ˆ Cognitive Disability ˆ Other Health Impairment ˆ Hearing Impairment ˆ Traumatic Brain Injury ˆ Autism ˆ Vision Impairment ˆ Emotional/Behavioral Disability ˆ Orthopedic Impairment – Type

Current Age Group ˆ Birth to Three ˆ Early Childhood ˆ Elementary ˆ Middle School ˆ Secondary

Classroom Setting ˆ Regular Education Classroom ˆ Resource Room ˆ Self-contained ˆ Home ˆ Other

Current Service Providers ˆ Occupational Therapy ˆ Physical Therapy ˆ Speech Language ˆ Other(s)

Medical Considerations (Check all that apply.) ˆ History of seizures ˆ Fatigues easily ˆ Has degenerative medical condition ˆ Has frequent pain ˆ Has multiple health problems ˆ Has frequent upper respiratory infections ˆ Has frequent ear infections ˆ Has digestive problems ˆ Has allergies to ˆ Currently taking medication for ˆ Other – Describe briefly

Other Issues of Concern

Assistive Technology Currently Used (Check all that apply.)

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ˆ None ˆ Low Tech Writing Aids ˆ Manual Communication Board ˆ Augmentative Communication System ˆ Low Tech Vision Aids ˆ Amplification System ˆ Environmental Control Unit/EADL ˆ Manual Wheelchair ˆ Power Wheelchair ˆ Computer – Type (platform) ˆ Voice Recognition ˆ Word Prediction ˆ Adaptive Input - Describe ˆ Adaptive Output - Describe ˆ Other Assistive Technology Tried Please describe any other assistive technology previously tried, length of trial, and outcome (how did it work or why didn’t it work.)

Assistive Technology Number and Dates of Trial(s)

Outcome

Assistive Technology Number and Dates of Trial(s)

Outcome

Assistive Technology Number and Dates of Trial(s)

Outcome

REFERRAL QUESTION What task(s) does the student need to do that is currently difficult or impossible, and for which assistive technology may be an option?

Based on the referral question, select the sections of the Student Information Guide to be completed. (Check all that apply.)

ˆ Section 1 Motor Aspects of Writing ˆ Section 8 Recreation and Leisure ˆ Section 2 Fine Motor Related to Computer ˆ Section 9 Seating and Positioning or Device Access

ˆ Section 3 Composing Written Material ˆ Section 10 Mobility ˆ Section 4 Communication ˆ Section 11 Vision ˆ Section 5 Reading ˆ Section 12 Hearing ˆ Section 6 Learning and Studying ˆ Section 13 General ˆ Section 7 Math

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WATI Student Information Guide SECTION 1 Fine Motor Related to Computer (or Device) Access

1. Current Fine Motor Abilities Observe the student using paper and pencil, typewriter, computer, switch, etc. Look at the movements as well as the activities and situations. Does the student have voluntary, isolated, controlled movements using the following? (Check all that apply.)

ˆ Left hand ˆ Right hand ˆ Eye(s) ˆ Left arm ˆ Right arm ˆ Head ˆ Left leg ˆ Right leg ˆ Mouth ˆ Left foot ˆ Right foot ˆ Tongue

ˆ Finger(s) ˆ Eyebrows ˆ Other

Describe briefly the activities/situations observed

2. Range of Motion Student has specific limitations to range. ˆYes ˆNo Describe the specific range in which the student has the most motor control.

3. Abnormal Reflexes and Muscle Tone Student has abnormal reflexes or abnormal muscle tone. ˆYes ˆNo Describe briefly any abnormal reflex patterns or patterns of low or high muscle tone that may interfere with the student’s voluntary motor control.

4. Accuracy Student has difficulty with accuracy. ˆYes ˆNo Describe how accurate, reliable and consistent the student is in performing a particular fine motor task.

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5. Fatigue Student fatigues easily. ˆYes ˆNo Describe how easily the student becomes fatigued.

6. Assisted Direct Selection What type of assistance for direct selection has been tried? (Check all that apply.) ˆ Keyguard ˆ Head pointer/head stick ˆ Pointers, hand grips, splints etc. ˆ Light beam/laser Other: Describe which seemed to work the best and why.

7. Size of Grid Student Is Able to Access What is the smallest square the student can accurately access? ˆ 1" ˆ 2" ˆ 3" ˆ 4" What is the optimal size grid? Size of square______Number of squares across______Number of squares down______8. Scanning If student cannot direct select, does the student use scanning? ˆ No ˆ Yes, if yes ˆ Step ˆ Automatic ˆ Inverse ˆ Other Preferred control site (body site) Other possible control sites

9. Type of Switch The following switches have been tried. (Check all that apply. Circle the one or two that seemed to work the best.)

ˆ Touch (jellybean) ˆ Light touch ˆ Wobble ˆ Rocker ˆ Joystick ˆ Lever ˆ Head switch ˆ Mercury (tilt) ˆ Arm slot ˆ Eye brow ˆ Tongue ˆ Sip/puff ˆ Tread ˆ Other

Summary of Student’s Abilities and Concerns Related to Computer/Device Access

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WATI Student Information Guide SECTION 2 Motor Aspects of Writing 1. Current Writing Ability (Check all that apply.) ˆ Holds pencil, but does not write ˆ Pretend writes ˆ Scribbles with a few recognizable letters ˆ Uses regular pencil ˆ Uses pencil adapted with ˆ Copies simple shapes ˆ Copies from book (near point) ˆ Copies from board (far point) ˆ Prints a few words ˆ Writes on 1" lines ˆ Prints name ˆ Writes on narrow lines ˆ Writes cursive ˆ Uses space correctly ˆ Writing is limited due to fatigue ˆ Sizes writing to fit spaces ˆ Writing is slow and arduous ˆ Writes independently and legibly

2. Assistive Technology Used (Check all that apply.)

ˆ Paper with heavier lines ˆ Paper with raised lines ˆ Pencil grip ˆ Special pencil or marker ˆ Splint or pencil holder ˆ Typewriter ˆ Computer ˆ Other

3. Current Keyboarding Ability (Check all that apply.) ˆ Does not currently type ˆ Activates desired key on command ˆ Types slowly, with one finger ˆ Types slowly, with more than one finger ˆ Accidentally hits unwanted keys ˆ Performs 10 finger typing ˆ Requires arm or wrist support to type ˆ Accesses keyboard with head or mouth stick ˆ Uses mini keyboard to reduce fatigue ˆ Uses switch to access computer ˆ Uses Touch Window ˆ Uses alternative keyboard ˆ Uses access software ˆ Uses Morse code to access computer ˆ Uses adapted or alternate keyboard, such as ˆ Other

4. Computer Use (Check all that apply.) ˆ Has never used a computer ˆ Uses computer at school ˆ Uses computer at home ˆ Uses computer for games ˆ Uses computer for word processing ˆ Uses computer’s spell checker ˆ Uses computer for a variety of purposes, such as ˆ Has potential to use computer but has not used a computer because

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5. Computer Availability and Use The student has access to the following computer(s) ˆ PC ˆ Macintosh ˆ Other ˆ Desktop ˆ Laptop Location:

The student uses a computer ˆ Rarely ˆ Frequently ˆ Daily for one or more subjects or periods ˆ Every day, all day

Summary of Student’s Abilities and Concerns Related to Writing

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WATI Student Information Guide SECTION 3 Composing Written Material

1. Typical of Student’s Present Writing (Check all that apply.) ˆ Short words ˆ Sentences ˆ Multi-paragraph reports

ˆ Short phrases ˆ Paragraphs of 2-5 sentences ˆ Other ˆ Complex phrases ˆ Longer paragraphs

2. Difficulties Currently Experienced by Student (Check all that apply.) ˆ Answering questions ˆ Generating ideas ˆ Getting started on a sentence or story ˆ Working w/peers to generate ideas and information ˆ Adding information to a topic ˆ Planning content ˆ Sequencing information ˆ Using a variety of vocabulary ˆ Integrating information from two or more sources ˆ Summarizing information ˆ Relating information to specific topics ˆ Other ˆ Determining when to begin a new paragraph

3. Strategies for Composing Written Materials Student Currently Utilizes (Check all that apply.) ˆ Story starters ˆ Webbing/concept mapping ˆ Preset choices or plot twists ˆ Outlines ˆ Templates to provide the format or structure ˆ Other (both paper and electronic)

4. Aids/Assistive Technology for Composing Written Materials Utilized by Student (Check all that apply.) ˆ Word cards ˆ Word book ˆ Word wall/word lists ˆ Prewritten words on cards or labels ˆ Dictionary ˆ Electronic dictionary/spell checker ˆ Whole words using software or hardware (e.g. IntelliKeys) ˆ Symbol-based software for writing (e.g. Writing with Symbols 2000 or Pix Writer) ˆ Word processing with spell checker/grammar checker ˆ Talking word processing ˆ Abbreviation/expansion ˆ Word processing with writing support ˆ Multimedia software ˆ Voice recognition software ˆ Other______

SUMMARY OF STUDENT’S ABILITIES AND CONCERNS RELATED TO WRITING

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WATI Student Information Guide SECTION 4 Communication

1. Student’s Present Means of Communication (Check all that are used. Circle the primary method the student uses.)

ˆ Changes in breathing patterns ˆ Body position changes ˆ Eye-gaze/eye movement ˆ Facial expressions ˆ Gestures ˆ Pointing

ˆ Sign language approximations ˆ Sign language (Type______# signs______

# combinations ______# signs in a combination ______) ˆ Vocalizations, list examples ˆ Vowels, vowel combinations, list examples ˆ Single words, list examples & approx. # ˆ Reliable no ˆ Reliable yes ˆ 2-word utterances ˆ 3-word utterances ˆ Semi intelligible speech, estimate % intelligible:______ˆ Communication board ˆ Tangibles ˆ Pictures ˆ Combination pictures/words ˆ Words ˆ Voice output AC device (name of device)

ˆ Intelligible speech ˆ Writing ˆ Other 2. Those Who Understand Student’s Communication Attempts (Check best descriptor.) Most of the time Part of the time Rarely Not Applicable Strangers ˆ ˆ ˆ ˆ Teachers/therapists ˆ ˆ ˆ ˆ Peers ˆ ˆ ˆ ˆ Siblings ˆ ˆ ˆ ˆ Parent/Guardian ˆ ˆ ˆ ˆ

3. Current Level of Receptive Language Age approximation ______If formal tests used, name and scores If formal testing is not used, please give an approximate age or developmental level of functioning. Explain your rationale for this estimate.

4. Current Level of Expressive Language Age approximation: ______If formal tests used, name and scores If formal testing is not used, please give an approximate age or developmental level of functioning. Explain your rationale for this estimate.

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5. Communication Interaction Skills Desires to communicate ˆ Yes ˆ No To indicate yes and no the student ˆ Shakes head ˆ Signs ˆ Vocalizes ˆ Gestures ˆ Eye gazes ˆ Points to board ˆ Uses word approximations ˆ Does not respond consistently

Can a person unfamiliar with the student understand the response? ˆ Yes ˆ No

Always Frequently Occasionally Seldom Never Turns toward speaker ˆ ˆ ˆ ˆ ˆ Interacts with peers ˆ ˆ ˆ ˆ ˆ Aware of listener’s attention ˆ ˆ ˆ ˆ ˆ Initiates interaction ˆ ˆ ˆ ˆ ˆ Asks questions ˆ ˆ ˆ ˆ ˆ Responds to communication interaction ˆ ˆ ˆ ˆ ˆ Requests clarification from communication partner ˆ ˆ ˆ ˆ ˆ Repairs communication breakdown ˆ ˆ ˆ ˆ ˆ Requires frequent verbal prompts ˆ ˆ ˆ ˆ ˆ Requires frequent physical prompts ˆ ˆ ˆ ˆ ˆ Maintains communication exchange ˆ ˆ ˆ ˆ ˆ Terminates communication ˆ ˆ ˆ ˆ ˆ

Describe techniques student uses for repair (e.g. keeps trying, changes message, points to first letter etc.).

6. Student’s Needs Related to Devices/Systems (Check all that apply.) ˆ Walks ˆ Uses wheelchair ˆ Carries device under 2 pounds ˆ Drops or throws things frequently ˆ Needs digitized (human) speech ˆ Needs device w/large number of words and phrases ˆ Other

7. Pre-Reading and Reading Skills Related to Communication (Check all that apply.) ˆ Yes ˆ No Object/picture recognition ˆ Yes ˆ No Symbol recognition (tactile, Mayer-Johnson, Rebus, etc.) ˆ Yes ˆ No Auditory discrimination of sounds ˆ Yes ˆ No Auditory discrimination of words, phrases ˆ Yes ˆ No Selecting initial letter of word ˆ Yes ˆ No Following simple directions ˆ Yes ˆ No Sight word recognition ˆ Yes ˆNo Putting two symbols or words together to express an idea

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8. Visual Abilities Related to Communication (Check all that apply.) ˆ Maintains fixation on stationary object ˆ Looks to right and left without moving head ˆ Scans line of symbols left to right ˆ Scans matrix of symbols in a grid ˆ Visually recognizes people ˆ Visually recognizes common objects ˆ Visually recognizes photographs ˆ Visually recognizes symbols or pictures ˆ Needs additional space around symbol ˆ Visually shifts horizontally ˆ Visually shifts vertically ˆ Recognizes line drawings

Is a specific type (brand) of symbols or pictures preferred?

What size symbols or pictures are preferred? What line thickness of symbols is preferred? inches

Does student seem to do better with black on white, or white on black, or a specific color combination for figure/ground discrimination?

Explain anything else you think is significant about the responses the student currently uses or his/her need for augmenting communication (Use an additional page if necessary)

Summary of Student’s Abilities and Concerns Related to Communication

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WATI Student Information Guide SECTION 5 Reading

1. The Student Demonstrates the Following Literacy Skills. (Check all that apply.) ˆ Engages in joint attention with adult caregiver to activities (e.g. songs, stories, games and/or toys) ˆ Shows an interest in books and stories with adult ˆ Shows and interest in looking at books independently ˆ Associates pictures with spoken words when being read to ˆ Realizes text conveys meaning when being read to ˆ Recognizes connection between spoken words and specific text when being read to ˆ Pretend writes and “reads” what he or she has written, even if scribbles ˆ When asked to spell a word, gets first consonant correct, but not the rest of the word ˆ Demonstrates sound manipulation skills including: ˆ Initial and final sounds in words ˆ Initial letter names/sounds ˆ Recognizes, names and prints the alphabet (if motor skills are limited, may use alternative means rather than printing to demonstrate knowledge of the alphabet)

ˆ When asked to spell a word, gets first and last sounds correct ˆ Applies phonics rules when attempting to decode printed words ˆ Sound blends words ˆ Reads and understands words in context ˆ Spells words using conventional spelling in situations other than memorized spelling tests ˆ Reads and understands sentences ˆ Composes sentences using nouns and verbs ˆ Reads fluently with expression ˆ Reads and understands paragraphs ˆ Composes meaningful paragraphs using correct syntax and punctuation

2. Student’s Performance Is Improved by (Check all that apply.) ˆ Smaller amount of text on page ˆ Enlarged print ˆ Word wall to refer to ˆ Pre-teaching concepts ˆ Graphics to communicate ideas ˆ Text rewritten at lower reading level ˆ Bold type for main ideas ˆ Reduced length of assignment ˆ Additional time ˆ Being placed where there are few distractions ˆ Spoken text to accompany print ˆ Color overlay (List color______) ˆ Other

3. Reading Assistance Used Please describe the non-technology based strategies and accommodations that have been used with this student

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4. Assistive Technology Used The following have been tried. (Check all that apply.) ˆ Highlighter, marker, template, or other self-help aid in visual tracking ˆ Colored overlay to change contrast between text and background ˆ Tape recorder, taped text, or talking books to “read along” with text ˆ Talking dictionary or talking spell checker to pronounce single words ˆ Hand held scanner to pronounce difficult words or phrases ˆ Computer with text to speech software to ˆ Speak single words ˆ Speak sentences ˆ Speak paragraphs ˆ Read entire document

Explain what seemed to work about any of the above assistive technology that has been tried.

5. Approximate Age or Grade Level of Reading Skills

6. Cognitive Ability in General ˆ Significantly below average ˆ Below average ˆ Average ˆ Above average

7. Difficulty Student has difficulty decoding the following. (Check all that apply.) ˆ Worksheets ˆReading Textbook ˆ Subject Area Textbooks ˆ Tests Student has difficult y comprehending the following. (Check all that apply.) ˆ Worksheets ˆ Reading Textbook ˆ Subject Area Textbooks ˆ Tests

8. Computer Availability and Use The student has access to the following computer(s): ˆ PC ˆ Macintosh 9. The Student Uses a Computer: ˆ Rarely ˆ Frequently ˆ Daily for one or more subjects or periods ˆ Every day, most of the day For the following purposes Summary of Student’s Abilities and Concerns Related to Reading

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WATI Student Information Guide SECTION 6 Learning and Studying

1. Difficulties Student Has Learning New Material or Studying (Check all that apply.) ˆ Remembering assignments ˆ Organizing information/notes ˆ Remembering steps of tasks or assignments ˆ Organizing materials for a report or paper ˆ Finding place in textbooks ˆ Turning in assignments ˆ Taking notes during lectures ˆ Other ˆ Reviewing notes from lectures

2. Assistive Technology Tried (Check all that apply.) ˆ Print or picture schedule ˆ Low tech aids to find materials (e.g. index tabs, color coded folders) ˆ Highlighting text (e.g. markers, highlight tape, ruler) ˆ Recorded material ˆ Voice output reminders for assignments, steps of task, etc. ˆ Electronic organizers ˆ Pagers/electronic reminders ˆ Hand held scanner to read words or phrases ˆ Software for manipulation of objects/concept development ˆ Software for organization of ideas and studying ˆ Palm computers ˆ Other

3. Strategies Used Please describe any adaptations or strategies that have been used to help this student with learning and studying.

Summary of Student’s Abilities and Concerns in the Area of Learning and Studying

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WATI Student Information Guide SECTION 7 Math

1. Difficulties Student Has with Math (Check all that apply.) ˆ Legibly writing numerals ˆ Understanding math related language ˆ Understanding meaning of numbers ˆ Understanding place values ˆ Understanding money concepts ˆ Completing simple addition and subtraction ˆ Completing multiplication and division ˆ Completing complex addition and subtraction ˆ Understanding units of measurement ˆ Understanding tables and graphs ˆ Creating graphs and tables ˆ Understanding time concepts ˆ Understanding fractions ˆ Working with fractions ˆ Converting to mixed numbers ˆ Understanding decimals /percents ˆ Solving story problems ˆ Understanding geometry ˆ Graphing ˆ Understanding the use of formulas ˆ Understanding and use of trigonometry functions ˆ Checking work ˆ Other

2. Assistive Technology Tried ˆ Abacus ˆ Talking calculator ˆ Math line ˆ Braille calculator ˆ Enlarged math worksheets ˆ Alternative keyboards (e.g. IntelliKeys) ˆ Low-tech alternatives for answering ˆ Math “Smart Chart” ˆ Recorded material ˆ Tactile math devices (ruler, clock, etc.) ˆ Voice output reminders for assignments, steps of task, etc. ˆ Electronic organizers ˆ Pagers/electronic reminders ˆ Single word scanners ˆ Software for manipulation of objects/concept development ˆ On screen scanning calculator ˆ Talking or Braille watch ˆ Software for organization of ideas & studying ˆ Palm computers ˆ Other

3. Strategies Used Please describe any strategies that have been used to help.

Summary of Student’s Abilities and Concerns Related to Math

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WATI Student Information Guide SECTION 8 Recreation and Leisure

1. Difficulties Student Experiences Participating in Recreation and Leisure (Check all that apply.) ˆ Understanding cause and effect ˆ Following complex directions ˆ Understanding turn taking ˆ Communicating with others ˆ Handling/manipulating objects ˆ Hearing others ˆ Throwing/catching objects ˆ Seeing equipment or materials ˆ Understanding rules ˆ Operating TV, VCR, etc. ˆ Waiting for his/her turn ˆ Operating computer ˆ Following simple directions ˆ Other

2. Activities Student Especially Enjoys

3. Adaptations Tried to Enhance Participation in Recreation and Leisure

How did they help?

4. Assistive Technology Tried (Check all that apply.) ˆ Toys adapted with Velcro®, magnets, handles etc. ˆ Toys adapted for single switch operation ˆ Adaptive sporting equipment, such as lighted or beeping ball ˆ Universal cuff or strap to hold crayons, markers, etc. ˆ Modified utensils, e.g. rubber stamps, rollers, brushes ˆ Ergo Rest or other arm support ˆ Electronic aids to control/operate TV, VCR, CD player, etc. ˆ Software to complete art activities ˆ Games on the computer ˆ Other computer software ˆ Other Summary of Student’s Abilities and Concerns in the Area of Recreation and Leisure

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WATI Student Information Guide SECTION 9 Seating and Positioning

1. Current Seating and Positioning of Student (Check all that apply.) ˆ Sits in regular chair w/ feet on floor ˆ Sits in regular chair w/ pelvic belt or foot rest ˆ Sits in adapted chair ˆ Sits in seat with adaptive cushion that allows needed movement ˆ Sits in wheelchair part of day ˆ Sits comfortably in wheelchair most of day ˆ Wheelchair in process of being adapted to fit ˆ Spends part of day out of chair due to prescribed positions ˆ Spends part of day out of chair due to discomfort ˆ Enjoys many positions throughout the day, based on activity ˆ Has few opportunities for other positions ˆ Uses regular desk ˆ Uses desk with height adjusted ˆ Uses tray on wheelchair for desktop ˆ Uses adapted table

2. Description of Seating (Check all that apply.) ˆ Seating provides trunk stability ˆ Seating allows feet to be on floor or foot rest ˆ Seating provides 90/90/90 position ˆ There are questions or concerns about the student’s seating ˆ Student dislikes some positions, often indicates discomfort in the following positions

ˆ Student has difficulty using table or desk ˆ There are concerns or questions about current wheelchair. ˆ Student has difficulty achieving and maintaining head control, best position for head control is

ˆ Can maintain head control for ______minutes in this position. Summary of Student’s Abilities and Concerns Related to Seating and Positioning

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WATI Student Information Guide SECTION 10 Mobility

1. Mobility (Check all that apply.) ˆ Crawls, rolls, or creeps independently ˆ Is pushed in manual wheelchair ˆ Uses wheelchair for long distances only ˆ Uses manual wheelchair independently ˆ Is learning to use power wheelchair ˆ Uses power wheelchair ˆ How do they access their power wheelchair ˆ Needs help to transfer in and out of wheelchair ˆ Transfers independently ˆ Has difficulty walking ˆ Walks with assistance ˆ Has difficulty walking up stairs ˆ Has difficulty walking down stairs ˆ Needs extra time to reach destination ˆ Walks independently ˆ Walks with appliance ˆ Uses elevator key independently

2. Concerns About Mobility (Check all that apply.) ˆ Student seems extremely tired after walking, requires a long time to recover ˆ Student seems to be having more difficulty than in the past ˆ Student complains about pain or discomfort ˆ Changes in schedule require more time for travel ˆ Changes in class location or building are making it more challenging to get around ˆ Transition to new school will require consideration of mobility needs

ˆ Other

Summary of Student’s Abilities and Concerns Related to Mobility

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WATI Student Information Guide Section 11 Vision

A vision specialist should be consulted to complete this section.

1. Date of Last Vision Report Report indicates (please address any field loss, vision condition, etc.)

2. Visual Abilities (Check all that apply.) ˆ Read standard textbook print ˆ Read text if enlarged to (indicate size in inches) ˆ Requires specialized lighting such as ˆ Requires materials tilted at a certain angle (indicate angle) ˆ Can read using optical aids, list: ˆ Currently uses the following screen enlargement device ˆ Currently uses the following screen enlargement software ˆ Recognizes letters enlarged to ______pt. type on computer screen ˆ Recognizes letters enlarged to ______pt. type for ______minutes without eye fatigue. ˆ Prefers ˆ Black letters on white ˆ White on black ˆ______(color) on ______ˆ Tilts head when reading ˆ Uses only one eye: ˆ Right eye ˆ Left eye ˆ Uses screen reader: ˆ Requires recorded material, text to speech, or Braille materials

3 Alternative Output Currently uses (Check all that apply.) ˆ Slate and stylus ˆ Talking calculator ˆ Braille calculator ˆ Braille notetaker ˆ Electric Brailler ˆ Refreshable Braille display ˆ Tactile images ˆ Screen reader ˆ Braille translation software:

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Level of proficiency (Check the one that most closely describes the student.) ˆ Requires frequent physical prompts ˆ Requires frequent verbal cues ˆ Needs only intermittent cues ˆ Uses device to complete tasks independently ˆ Trouble-shoots problems related to device

4. Writing/Handwritten Materials (Check all that apply.) ˆ Writes using space correctly ˆ Writes on line ˆ Writes appropriate size ˆ Reads own handwriting ˆ Reads someone else’s writing ˆ Reads hand printing ˆ Reads cursive ˆ Skips letters when copying ˆ Requires bold or raised-line paper ˆ Requires softer lead pencils ˆ Requires colored pencils, pens, or paper ˆ Requires felt tip pen ˆ Thin point ˆ Thick point

Summary of Student’s Abilities and Concerns Related to Vision

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WATI Student Information Guide SECTION 12 Hearing

A hearing specialist should be consulted to complete this section.

1. Audiological Information

Date of last audiological exam______

Hearing loss identified

Right Ear ˆ Mild ˆ Moderate ˆ Severe ˆ Profound

Left Ear ˆ Mild ˆ Moderate ˆ Severe ˆ Profound

Onset of hearing loss Etiology

2. Unaided Auditory Abilities (Check all that apply.)

ˆ Attends to sounds ˆ High pitch ˆ Low pitch ˆ Voices ˆ Background noises ˆ Discriminates environmental vs. non-environmental sounds ˆ Turns toward sound ˆ Hears some speech sounds ˆ Understands synthesized speech

3. Student’s Eye Contact and Attention to Communication (Check best descriptor.)

ˆ Poor ˆ Inconsistent ˆ Limited ˆ Good ˆ Excellent

4. Communication Used by Others Indicate the form of communication generally used by others in each of the following environments. (Check all that apply.) School Home Community

ˆ Body language ˆ ˆ ˆ

ˆ Gestures ˆ ˆ ˆ

ˆ Speech ˆ ˆ ˆ

ˆ Cued speech ˆ ˆ ˆ

ˆ Picture cues ˆ ˆ ˆ

ˆ Written messages ˆ ˆ ˆ

ˆ Signs and speech together ˆ ˆ ˆ

ˆ Signed English ˆ ˆ ˆ

ˆ Contact (Pidgin) sign language ˆ ˆ ˆ

ˆ American Sign Language (ASL) ˆ ˆ ˆ

5. Level of Receptive Proficiency in Each Environment School Home Community

ˆ Understands single words ˆ ˆ ˆ

ˆ Understands short phrases ˆ ˆ ˆ

ˆ Understands majority of ˆ ˆ ˆ

communications

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6. Student Communicates with Others Using (Check all that apply)

ˆ Speech ˆ American Sign Language ˆ Body language

ˆ Signs and speech together ˆ Gestures ˆ Written messages

ˆ Signed English ˆ Picture cues ˆ Contact (Pidgin) sign language

ˆ Other______

Level of expressive communication: ˆ Single words ˆ Combination of words ˆ Proficient

7. Is There a Discrepancy Between Receptive and Expressive Abilities? ˆ Yes ˆ No If yes, describe further.

8. Services Currently Used (Check all that apply) ˆ Audiology ˆ Note taker ˆ Educational interpreter using: ˆ ASL ˆ Transliterating ˆ PSE ˆ Oral

9. Equipment Currently Used (Check all that apply.) ˆ Hearing aids ˆ Cochlear implant ˆ Telecaption decoder

ˆ Vibrotactile devices ˆ Classroom amplification system ˆ TTY/TDD

ˆ FM system ˆ Other

10. Present Concerns for Communication, Writing, and/or Educational Materials

ˆ Cannot hear teacher/other students ˆ Cannot respond to emergency alarm

ˆ Cannot participate in class discussions ˆ Cannot benefit from educational videos/programs

ˆ Displays rec./exp. language delays ˆ Cannot use telephone to communicate

11. Current communication functioning (Check all that apply) ˆ Desires to communicate ˆ Initiates interaction ˆ Responds to communication requests ˆ Reads lips ˆ Appears frustrated with current communication functioning ˆ Requests clarification from communication partners (“Would you please repeat that?”) ˆ Repairs communication breakdown (Keeps trying, changes message)

12. Current Reading Level

Summary of Hearing Abilities and Concerns

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WATI Student Information Guide Section 13 General

Are there any behaviors (both positive and negative) that significantly impact the student’s performance?

Are there significant factors about the student’s strengths, learning style, coping strategies or interests that the team should consider?

Are there any other significant factors about the student that the team should consider?

Does student fatigue easily or experience a change in performance at different times of the day?

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Environmental Observation Guide

Student’s name: School: Observer: Date of Observation: Type of class:

Directions: Complete this Environmental Assessment Checklist before beginning

Describe the environment: Record short responses in the space provided. Special or general education classroom? Specialty classroom (Specify: e.g., P.E., computer lab) Therapy room? (Specify) Number of teachers in class? Number of aides in class? Number of volunteers in class? Number of students in the class? How many days per week is the program? How many hours/day? Is the atmosphere busy or quiet? Are there large open areas or small divided sections? How are the desks arranged? Is the furniture sized for children? Are materials accessible, appropriate, varied, interesting? Is special equipment available (i.e., chairs with arm supports)? Where is the classroom located in relationship to the cafeteria, therapy, outdoor play areas, etc.? Are bathrooms located in or outside the classroom?

Sensory Stimulation: Judge the level of sensory stimulation and record it with a check in the corresponding box. Enter comments or notes that clarify your responses if needed. Excessive Balanced Reduced N/A Comments Auditory Hallway Street Other classrooms Other students Instructional media Teacher aides/volunteers Other (specify):

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Sensory Stimulation: continued Excessive Balanced Reduced Comments Visual Color Clutter/busy Art/decorations Visual information Lighting Other (specify):

Persons Present During Observation: For each person on the list, put a check in the appropriate column indicating their level of participation.

Persons Participating Observing Not Present Student Special Educator General Educator Peer Tutors (How many? _____) Instructional Assistant #1 Instructional Assistant #2 Instructional Assistant #3 Personal Attendant Speech-Language Pathologist Occupational Therapist Physical Therapist School Psychologist Parent Volunteer Administrator AT Specialist Other (specify): Notes:

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Access to Assistive Technology: Record the presence or absence of EACH TYPE of assistive technology by placing a check in the corresponding box. Record the AT found in the classroom as a whole, not just the AT used by the target student. Types Present-Not Used Present-Used Not Present Communication cards/boards Digitally recorded communication devices Electronic communication devices AT for activities of daily living Adjustable seating (not a wheelchair) Positioning equipment Amplification Visual signaling devices Brailler/brailled materials Magnifiers Notetaking devices/keyboards Speech output devices/computers Handwriting aids Alternate/adapted keyboards Alternate/adapted mouse Computer switch interface Touch window Talking word processor/word prediction/abbreviation & expansion Transfer aids - Hoists/lifts Mobility aids (not wheelchairs) Adapted environment (e.g., doors, fixtures, furniture) Electronic equipment for instruction (calculator, e-books) Adapted instructional materials Instructional software Computer stations Adapted art/craft materials Adapted sports/recreation equipment Adapted toys Other (specify):

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Environmental Observation Summary

Activity/Task(s) observed:

Ways that typical students participated:

Ways the target student participated:

Barriers to target student’s participation:

Adapted from: Wirkus-Pallaske, M., Reed, P., & Stokes, S. (2000). Wisconsin Assistive Technology Initiative. Oshkosh, WI: Wisconsin Assistive Technology Initiative. Center for Instructional Development and Research. (1998). Classroom observation. CIDR Teaching and Learning Bulletin, 1(4), Available online: http://depts.washington.edu/ObsTools.htm Pearson, L. (no date). Apraxia guide: Classroom observation checklist. Available online: http://hometown.aol.com/lynetteprs/myhomepage/profile.html

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WATI Assistive Technology Decision Making Guide

Referral Question

PROBLEM IDENTIFICATION Student’s Environmental Tasks Abilities/Difficulties Considerations

Writing/Use of Hands e.g. Classroom e.g. Produce legible written material Communication Playground Produce audible speech Reading/Academics Lunch Room Read text Mobility Home, etc. Complete math problems Vision In Each: Participate in recreation/leisure Hearing Technology Equipment Move independently in the school Behavior Available environment Other Room Arrangement, Lighting Sound Activities, etc. Reframed Question

i.e. Specific task identified for solution generation

SOLUTION GENERATION Solution Selection Implementation Plan

Brainstorming Only Discuss & Select Idea from AT Trials/Services Needed: No Decision Solution Generation Date Length Person Responsible

Follow-Up Plan

Who & When Set specific date now.

Important: It is intended that you use this as a guide. Each topic should be written in large print where everyone can see them, i.e. on a flip chart or board. Information should then be transferred to paper for distribution, file, and future reference.

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WATI Assistive Technology Assessment Technology Checklist COMPUTER ACCESS READING, STUDYING, AND MATH

ˆ Keyboard using accessibility options Reading ˆ Word prediction, abbreviation/expansion to reduce keystrokes ˆ Standard text ˆ Keyguard ˆ Predictable books ˆ Arm support ˆ Changes in text size, spacing, color, background color ˆ Track ball/track pad/joystick with on-screen keyboard ˆ Book adapted for page turning (e.g. page fluffers, 3-ring binder) ˆ Alternate keyboard ˆ Use of pictures/symbols with text ˆ Mouth stick/head mouse with on-screen keyboard ˆ Talking electronic device/software to pronounce ˆ Switch with Morse code challenging words ˆ Switch with scanning ˆ Single word scanners ˆ Voice recognition software ˆ Scanner w/OCR and text to speech software ˆ Other: ______ˆ Software to read websites and emails WRITING ˆ Other: ______Motor Aspects of Writing Learning/Studying ˆ Regular pencil/pen ˆ Pencil/pen with adaptive grip ˆ Print or picture schedule ˆ Adapted paper (e.g. raised line, highlighted lines) ˆ Low tech aids to find materials (e.g. index tabs, color coded ˆ Slantboard folders) ˆ Use of prewritten words/phrases ˆ Highlight text (e.g. markers, highlight tape, ruler, etc.) ˆ Portable word processor to keyboard instead of write ˆ Recorded material (books on tape, taped lectures with number coded index, etc.) ˆ Computer with word processing software ˆ Voice output reminders for assignments, steps of task, etc. ˆ Portable scanner with word processing software ˆ Electronic organizers ˆ Voice recognition software to word process ˆ Pagers/electronic reminders ˆ Other: ______ˆ Single word scanners Composing Written Material ˆ Hand-held scanners ˆ Word cards/word book/word wall ˆ Software for concept development/manipulation of objects – ˆ Pocket dictionary/thesaurus may use alternate input device, e.g. switch, Touch Window ˆ Writing templates ˆ Software for organization of ideas and studying ˆ Electronic/talking electronic dictionary/thesaurus/spell ˆ Palm computers checker ˆ Other: ______ˆ Word processing with spell checker/grammar checker ˆ Talking word processing Math ˆ Abbreviation/expansion ˆ Abacus/Math Line ˆ Word processing with writing supports ˆ Enlarged math worksheets ˆ Multimedia software ˆ Low tech alternatives for answering ˆ Voice recognition software ˆ Math “Smart Chart” ˆ Other: ______ˆ Money calculator and Coinulator ˆ Tactile/voice output measuring devices COMMUNICATION ˆ Talking watches/clocks ˆ Communication board/book with pictures/objects/ ˆ Calculator/calculator with printout letters/words ˆ Calculator with large keys and/or large display ˆ Eye gaze board/frame communication system ˆ Talking calculator ˆ Simple voice output device ˆ Calculator with special features (e.g. fraction translation) ˆ Voice output device w/levels ˆ On-screen/scanning calculator ˆ Voice output device w/icon sequencing ˆ Alternative keyboard ˆ Voice output device w/dynamic display ˆ Software with cueing for math computation (may use ˆ Device w/speech synthesis for typing adapted input methods) ˆ Other: ______ˆ Voice recognition software ˆ Other: ______

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RECREATION AND LEISURE VISION ˆ Toys adapted with Velcro, magnets, handles, etc. ˆ Eye glasses ˆ Toys adapted for single switch operation ˆ Optical aids ˆ Adaptive sporting equipment (e.g. lighted or beeping ˆ Large print materials ball) ˆ Auditory materials ˆ Universal cuff/strap to hold crayons, markers, etc. ˆ Dictation software (voice input) ˆ Modified utensils (e.g. rubber stamps, brushes, etc.) ˆ CCTV (closed circuit television) ˆ Ergo Rest or other arm support for drawing/painting ˆ Screen magnifier (mounted over screen) ˆ Electronic aids to control/operate TV, VCR, CD player, ˆ Screen magnification software etc. ˆ Screen color contrast ˆ Software ˆ Screen reader, text reader ˆ Completion of art activities ˆ Braille notetaker ˆ Games on the computer ˆ Braille translation software ˆ Other computer software ˆ Braille embosser ˆ Other: ______ˆ Enlarged or Braille/tactile labels for keyboard

ˆ Alternate keyboard ACTIVITIES OF DAILY LIVING (ADLS) ˆ Other: ______ˆ Non slip materials to hold things in place ˆ Universal cuff/strap to hold items in hand HEARING ˆ Color coded items for easier locating and identifying ˆ Pen and paper ˆ Adaptive eating utensils (e.g. foam handles, deep sides) ˆ Computer/portable word processor ˆ Adaptive drinking devices (e.g. cup with cut-out rim) ˆ TDD for phone access with or without relay ˆ Adaptive dressing equipment (e.g. button hook, elastic ˆ Signaling device (e.g. flashing light or vibrating pager) shoelaces, Velcro instead of buttons, etc.) ˆ Closed captioning ˆ Adaptive devices for hygiene (e.g. adapted toothbrush, ˆ Real Time captioning raised toilet seat, etc.) ˆ Computer aided note taking ˆ Adaptive bathing devices ˆ Screen flash for alert signals on computer ˆ Adaptive equipment for cooking ˆ Phone amplifier ˆ Other: ______ˆ Personal amplification system/hearing aid ˆ FM or loop system MOBILITY ˆ Infrared system ˆ Walker ˆ Other: ______ˆ Grab bars and rails ˆ Manual wheelchair including sports chair ˆ Powered mobility toy (e.g. Cooper Car, GoBot) COMMENTS ˆ Powered scooter or cart ˆ Powered wheelchair w/ joystick or other control ˆ Adapted vehicle for driving ˆ Other: ______

POSITIONING AND SEATING ˆ Non-slip surface on chair to prevent slipping (e.g. Dycem) ˆ Bolster, rolled towel, blocks for feet ˆ Adapted/alternate chair, sidelyer, stander ˆ Custom fitted wheelchair or insert ˆ Other: ______

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WATI Assistive Technology Trial Use Guide

AT to be tried:

Student’s Name: DOB: Age: Meeting Date:

School/Agency: Grade/Placement:

Contact Person(s):

School/Agency Phone: Address:

Persons Completing Guide:

Parent(s) Name: Phone:

Parent(s) Address:

Goal for AT use:

ACQUISITION Date(s) Date Date Source(s) Person Responsible Available Received Returned

Person primarily responsible to learn to operate this AT:

Training Date Date Person(s) to be trained Training Required Begun Completed

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MANAGEMENT/SUPPORT Support to be provided Person Location(s) (e.g. set up, trouble shoot, recharge, program, etc.) Responsible

Student Use Time Date Location Task(s) Outcome(s) Used

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WATI Assistive Technology Trial Use Summary

Student’s Name: ______Age: ____Date Completed:

Person(s) Completing Summary:

Task Being Addressed During Trial

Criteria for Success

Dates Criteria Comments (e.g. advantages, disadvantages, AT Tried Used Met? preferences, performance)

Recommendations for IEP:

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